Maxwell Sandberg, Gregory Russell, Jacob Malakismail, Mitchell Hayes, Reuben Ben David, Justin Miller, Kartik Patel, Brejjette Aljabi, Seok‐Soon Byun, Oscar Rodriguez Faba, Donato Cannoletta, Tatiana Letowski, Gustavo Villoldo, Patricio Garcia Marchinena, Thiago Mourao, Gaetano Ciancio, Charles C. Peyton, Rafael Zanotti, Philippe E. Spiess, Reza Mehrazin, Diego Abreu, Stenio de Cassio Zequi, Alejandro Rodriguez.

Abstract

The gold standard treatment for renal cell carcinoma with a tumor thrombus (RCC-TT) is radical nephrectomy with tumor thrombectomy (RN-TT). Operative approaches to this can be done open (ORN-TT), laparoscopic (LRN-TT), or robotic (RRN-TT). The purpose of this study was to compare overall survival (OS), cancer-specific survival (CSS), and metastasis-free survival (MFS) between open, laparoscopic, and robotic approaches to RN-TT using the Intercontinental Collaboration on Renal Cell Carcinoma (ICORCC) database. Patient records were reviewed from the ICORCC database. All patients included in the study underwent RN-TT for RCC-TT from 1999 to present. Tumor thrombus level was graded using the Neves classification system. Statistical analysis was carried out using analysis of variance, chi-squared test, and Kaplan–Meier survival curves with log-rank test to compare outcomes by surgical approach. A total of 392 patients were included. There were 308 ORN-TT, 61 LRN-TT, and 23 RRN-TT cases. On Kaplan–Meier analysis, OS and CSS were not significantly different by approach (p>0.05). MFS was significantly lower in RRN-TT patients (p=0.030). Operative time was the longest in ORN-TT, followed by LRN-TT, and RRN-TT the quickest (p=0.011). Blood transfusion rates were significantly lower in RRN-TT relative to ORNTT (p<0.001). Rates of lymph node dissection, soft tissue margin positivity, and cytoreductive surgery were alike (p>0.05). There is no definitive superiority of one operative approach compared to another. RRN-TT may result in worse MFS for patients, which calls for further investigation, but this is not certain. Ultimately, the risks, benefits, and resources the surgeon has at his/her disposal should all play in the final operative choice of RN-TT for the patient.

Keywords

Thrombus · Renal cell carcinoma · Robotic · Urology · Laparoscopic